3Suffixes Pertaining to Surgery and Other Procedures Write the meaning of each of the following suffixes (p. 197, table 12.1)Ectomy:Orrhaphy:Oscopy:Ostomy:Otomy:Plasty:
4Purposes of Surgery ICurative: involves the repair of deficits, the removal of abnormal or diseased tissue.Diagnostic or Exploratory: may involve using a scope to look at tissue abnormalities or an excision of tissue for study to make a diagnosis.
5Purposes of Surgery IICosmetic or reconstructive: performed to correct deficits or to improve appearance.Preventive: done to remove tissue before it causes a problem.Palliative: performed to improve symptoms or increase the quality of life.
7Urgency LevelsEmergency: required when life or loss of a limb is a threat without immediate surgery.Urgent: procedure is required within a 24 to 30 hour time period.Elective: can be scheduled and planned at will without time constraints.Optional: done to fulfill an individuals desire.
8Define each of the following four terms (p.198, table 12.3) Perioperative PhasesDefine each of the following four terms (p.198, table 12.3)Perioperative:Preoperative:
9Perioperative Phases Continued Intraoperative:Postoperative:
10Preoperative phase Priority Nursing Goal Identify and implement actions that reduce surgical risk factors.Implement interventions facilitating best possible surgical outcomes and maximal achievement.
11Preoperative Phase Role of the LPN: Assist with data collection and care plan developmentProvide emotional and psychological support for patient and familyReinforce and clarify information and instructions given to the patient and family.
12Preoperative Phase Preadmission Process: Preadmission Testing departmentPrescreening, teaching, & answers to questions decreased anxiety.Interview process includes health history, identification of risk factors, laboratory testing, x-rays, ECGs, referrals, discharge planning
13Preoperative Phase Preadmission Process II: Federal Law mandates that patients must be asked if they have advanced directives in place prior to surgery.Copies must be placed in the chartExamples: power of attorney, living will
14Preoperative Phase Preadmission Process III: Admission process teaching includes:Date & time of admission and surgeryArrival time: completion of admission proceduresLOS and items to bring: glasses,shoes, hearing aidesAnticipated recovery time
15Preoperative Phase Preadmission Process IV: Admission process teaching continued:Family information: waiting room, visiting policies, what to expect, contact person.Discharge information: responsible adult, transportation home
16Preoperative Phase Preoperative teaching I: NPO status usually starts at midnight the night before surgery. Clear liquids may be allowed up to 4 hours prior to surgery.Medications to takeSpecial preparationsTeach postoperative routines and procedures during preoperative phase
18Preoperative Phase Preoperative teaching III: Incentive spirometry teaching:(Review procedure p. 202)Incision splintingPositions that reduce strain on incisions(review p. 202 table 12.5)Change position slowly
19Preoperative Phase Emotional responses Name some emotional responses that may occur with patients or their families during the preoperative phase.Anxiety results from uncertainties
20Preoperative Phase Emotional responses II NURSES NEED TO BE AWARE OF EMOTIONAL REACTIONS TO ASSIST INDIVIDUALS IN COPING WITH THEM!
21Preoperative Phase Stress Reduction Techniques Anesthesiologist visitGuided ImageryFocused breathingTeaching what to expectDiscuss Pain ManagementMusicFamily members
22Preoperative Phase Nutrition & Hydration I Normal fluid and electrolyte balances decrease complications.Adequate nourishment facilitates normal healing and recovery: correct nutritional deficiencies prior to surgery.Protein, vitamin C, & zinc foster proper wound healing, collagen formation, tissue repair & tissue growth.
23Preoperative Phase Nutrition & Hydration II Assess Albumin levelsEncourage to lose weight prior to elective surgeryAssess hemoglobin and hematocrit levelsAll botanical products (herbs) should be stopped two weeks prior to surgery.
24Preoperative Phase Smoking (increases risk for complications) Thickens and increases the amount of respiratory secretionsReduces the action of ciliaSmoking should be avoided 24 hours prior to surgery and for a least 3 weeks with chronic lung disordersSlows wound healing (peripheral constriction)
25Preoperative Phase Alcohol (Increases risk for complications) Long-term use of alcohol causes liver damage and causes nutritional deficiencies.May cause postoperative bleeding problems.Causes altered metabolism of medications and interactions with medications
26Preoperative Phase Chronic disorders (Increase risk for complications) Chronic disorders must be well controlled to prevent complications.Examples:DiabetesChronic lung disordersImmunity disordersRenal insufficiency or failure
27Preoperative Phase Nursing process: assessment & data collection Subjective data:Previous experiences with anesthesia (i.e.: allergies or adverse reactions)Medications (including over-the-counter, herbs, & recreational)Alcohol & smoking historyMedical & surgical historyBaseline history: chronic illness, conditionsWhat does the patient see as the reason for surgery? What is the related condition?
28Preoperative Phase Nursing process: assessment & data collection Objective Data:System assessments: establish baselinesCoughs, fever, infections, abnormal lung sounds are reported to the physician.Dentures, bridges, capped teeth, or loose teethDiagnostic tests (p. 201 table 12.4): electrolytes, CXR, ABG, PTT, INR, PT, type & cross match, BUN, Creatinine, CBC
29Preoperative Phase Nursing process: assessment & data collection Preoperative Checklist (p. 206 figure 12.4)Completed and signed by nurse prior to sending to the OR.Removal of hairpins, wigs, dentures, nail polish, jewelry, artificial nails, makeup (Hearing aids & glasses may be removed in the holding area)Preparations completed (I.e.: shaving, antimicrobial baths)ID band checked and in placePreoperative consent signed
30Preoperative Phase Nursing process: assessment & data collection Preoperative Consent:Legal permission2 purposes: protects patient from unauthorized surgery & protects hospital & health care personnel from claims that the procedure was unauthorized.Consent is voluntary, written, & informed.The patient must understand the procedure, the anticipated outcomes, and risks.
31Preoperative Phase Preparation Preoperative medications:Administered about 1 hour prior to surgeryAntianxiety & sedative agentsAnticholinergicsAntiemeticsHistamine (H2) antagonistsAntibiotics
32Preoperative Phase Preparation Transfer to surgery:Family may escort patientSurgical holding areaWaiting rooms/areas: communication centersBeepers
34Intraoperative Phase: Skin preparation Prepping solution: providone-iodine (betadine) Know allergies!!!Microorganisms on skin potential for systemic infectionScrub: completed in a circular motion (inner to outer)
35Intraoperative Phase: Nursing roles SAFETY SAFETY SAFETY SAFETYVerification: patient name, allergies, confirm procedure (side & site: involve patient), confirm completion of documents (informed consent, pre-op check list, labs)Verification that documentation of history/pre-operative exams & anesthesiologist pre-op visit is present
36Intraoperative Phase: Nursing Roles Explain what to expect:EquipmentOR personal/ teamTemperatureOR table
37Intraoperative Phase: Anesthesia Purpose: prevent pain, prevent fright (anxiety) and allow procedure to be completed safely.General Anesthesia: given by IV or inhalationLocal Anesthesia: local injections
38Intraoperative Phase: General Anesthesia List considerations for making general anesthesia the method of choice (p. 211):
39Intraoperative Phase: General Anesthesia Induction: a period that begins with the administration of an anesthetic agent and ends with the achievement of full anesthesia.After anesthesia is induced, the patient is quickly intubatedAgents act directly on CNS impulses loss of sensation, consciousness, & reflexes (including respiratory).
40Intraoperative Phase: General Anesthesia IV agents: quick acting, short acting.Generally used for induction.Inhalation agents: generally used to maintain anesthesiaInhalation agents are delivered, controlled, & excreted through the mechanical ventilation system.
41Intraoperative Phase: General Anesthesia Potential complications of inhalation agentsIrritation to respiratory tractLaryngospasmLaryngeal edemaVocal cord injury Intubation also has potential to cause respiratory tract complications
42Intraoperative Phase: General Anesthesia Adjunct Agents: medication used with primary anesthetic agentsNarcoticsMuscle relaxersAntiemeticsSedatives
43Intraoperative Phase: General Anesthesia Malignant Hyperthermia: rare hereditary muscular disorder triggered by some types of general anesthetic agents. It is a life-threatening disorder.S&S: increased muscular metabolism high fever, muscle rigidity, tachypnea, HTN, tachycardia, hyperkalemia, dysrhythmias, & cyanosis.
44Intraoperative Phase: General Anesthesia Malignant Hyperthermia (cont.):Obtaining history is importantIncreased risk with HX of heat strokeTreatment:Cooling: icing & cooled solution infusions100% O2Muscle relaxants: dantrolene sodium (Dantrium) is always kept available in the OR (per protocol).
45Intraoperative Phase: Local (Regional) Anesthesia Significantly less associated complicationsList factors indicating that local anesthesia is an appropriate choice.
46Intraoperative Phase: Local (Regional) Anesthesia Local agents: bupivacaine hydrochloride (Marcaine), lidocaine (Xylocaine)Local infultration:Topical administration:Regional blocksNerve block:Bier block:Field block:
47Intraoperative Phase: Local (Regional) Anesthesia Spinal & Epidural Blocks: (p. 212, fig 12.9)Spinal block: injection into subarachnoid spaceEpidural block: injection into the epidural spaceUsed mainly with lower abdominal or lower extremity procedures
48Intraoperative Phase: Local (Regional) Anesthesia Spinal & Epidural Blocks (cont.)Both motor and sensory function is blocked.Complications: blocked sympathetic stimulation vasodilation hypotension, venous return & cardiac outputHeadache, photophobia, double visionRespiratory depression
49Intraoperative Phase: Local (Regional) Anesthesia Spinal & Epidural Blocks (cont.)
50Intraoperative Phase: Local (Regional) Anesthesia Spinal & Epidural Blocks (cont.)Most common complication: post-procedural headacheCause: leakage/ loss of CSF fluidPrevention: use of small needle (< 25 G).TX: keep flat, encourage PO fluids, analgesics. If leakage persists blood patch.
51Intraoperative Phase: Conscious Sedation Does not cause complete loss of consciousnessPatients are comfortable, maintain patient airway, & respond appropriately to commands.Sedative, hypnotics, & opioids are usedPatient awakens easily & quickly after the procedurePatient is monitored until all drug effects have worn off.
52Intraoperative Phase: Conscious Sedation (cont.) Class ActivityList seven conditions that should be met before discharging a patient home after receiving conscious sedation (p )
53Intraoperative Phase: Conscious Sedation VS General Anesthesia Allows patients to more quickly return to baseline functionCauses less CNS, respiratory, and cardiovascular system depressionRequires less medicationIs less invasive
54Intraoperative Phase: Perianesthesia Nursing Assessments SafetyReadiness for transfer to/from PACUAirway, respiratory, & neurologicalVital signs & painSurgical siteAnesthetic effects (reversal)IV sites and fluids
55Postoperative PhaseWhen does the postoperative stage begin & end? (p. 213)
56Postoperative Phase: Admission to PACU System assessments are completed upon admission.Nursing tasks include: O2 administration, monitoring, drainage, hematoma, drains, catheters, NGTs, temperature, warming blankets, incisions, communicate with familyDischarge criteria: (p. 216, table 12.8)
57Postoperative Phase: HYPOTHERMIA Results from cool OR environment, IV fluids,anesthesia, heat loss; elderly are at increased risk.Shivering increases O2 consumption by 400 to 500%Demerol is an effective TX when anesthesia is the cause.Normal temperature is one criteria for discharge.
59Postoperative Phase: Priority Nursing Goals Prevent complicationsFacilitate optimal outcomes within expected time periodsPromote independent functionClient education
60Postoperative Phase: Nursing Unit Room Preparation Surgical bed with clean linens, waterproof pads, lift sheet, extra pillows, suction set-up, O2 set up, special equipment, washcloths, remove water pitchers, IV pumps, irrigation supplies
61Postoperative Phase: Circulatory Assessments & Interventions Prevent & detect hemorrhage, shock, thrombophlebitis, & thrombosis1) Assess incision for hematoma & drainage (assess drains)2) Tenderness or pain in calf: question DVT3) Peripheral pulses & capillary refill4) Implement compression devices & leg exercises
62Postoperative Phase: Respiratory Assessments & Interventions Prevent pneumonia & atelectasisAssess lung sounds and breathing patternMobilityCoughing, deep breathing, use of incentive spirometer
63Postoperative Phase: Gastrointestinal Assessments & Interventions Motility & function is affected by anesthesia & surgery (handling of bowel), immobility, nausea & vomiting.Paralytic ileus:Assess bowel sounds & distentionMotility & flatus is usually absent for 24 to 72 hours postoperatively
64Postoperative Phase: Gastrointestinal Assessments & Interventions (cont.) Kept NPO until bowel sounds and flatus return.Nasogastric tubes: decompression of GI tract risk for electrolyte imbalance; assess drainage.Nutrition is important: advance from clear liquid diet to regular diet; “advance diet as tolerated”Well nourished adults generally have nutrient reserves for 3 to 4 days.
65Postoperative Phase: Wound Assessment & Interventions Successful wound assessment requires knowledge of healing phases & intentions.Potential complications: infection, hematoma, dehiscense, evisceration (fig p. 224)Assessment: inspection of site & drainage
67Postoperative Phase: Discharge criteria Length of stay varies depending on the surgical procedure & the individual needs of the patient.Discharge planning begins on the day of admissionStable statusDischarge instructionsCapable of independent careSafety considerations
68Postoperative Phase: Referral to home health care Refer when client requires:1) Assistance with care tasks (i.e.: wound, ostomy, IV, injection, ect.)2) Continued teaching: i.e.: diabetes care, crutch walking, artificial limbs, O2 usage3) Support: social support, home adaptations, compliance, development of complications